Tympanoplasty Abroad: Eardrum Repair Surgery Guide 2025

Understanding Eardrum Perforation

The tympanic membrane, commonly known as the eardrum, is a thin, cone-shaped membrane that separates the external ear canal from the middle ear. It serves two essential functions: transmitting sound vibrations to the ossicles (small bones) of the middle ear for hearing, and protecting the middle ear from water, bacteria, and other foreign substances. A perforation or hole in the eardrum disrupts both functions, causing conductive hearing loss as sound transmission is impaired, and increasing the risk of middle ear infections as the protective barrier is compromised. The severity of hearing loss depends on the size and location of the perforation, with larger perforations and those affecting the posterior portion of the eardrum typically causing greater hearing impairment.

Eardrum perforations can result from various causes including chronic ear infections (the most common cause), acute trauma from objects inserted into the ear canal, blast injury from explosions or slapping, barotrauma from rapid pressure changes during flying or diving, and following tympanostomy tube extrusion when the tubes placed for chronic middle ear effusion leave a persistent hole. Some perforations heal spontaneously, particularly small traumatic perforations in otherwise healthy ears. However, chronic perforations, those caused by infection, and perforations that have been present for more than three months are unlikely to close without surgical repair. Acıbadem Maslak Hospital provides comprehensive otological evaluation including microscopic examination, audiometric testing, and CT scanning when needed to fully characterize the perforation and any associated middle ear disease before recommending surgical repair.

The decision to pursue tympanoplasty abroad is often motivated by the combination of high surgical costs in Western countries and long waiting times in public healthcare systems. In the United States, tympanoplasty costs $5,000 to $12,000 depending on the complexity of the repair and whether middle ear reconstruction is required. In the UK, NHS waiting times for non-urgent ear surgery can extend to six months or longer, during which patients must protect their ear from water and risk repeated infections. International ENT centers offer the same procedures at 60 to 80 percent lower cost with immediate availability, performed by experienced otological surgeons using modern microsurgical techniques and equipment. The combination of cost savings, eliminated waiting times, and high-quality surgical care makes tympanoplasty abroad an increasingly popular choice.

Surgical Techniques for Eardrum Repair

Myringoplasty is the simplest form of eardrum repair, involving closure of a perforation without reconstruction of the middle ear structures. This procedure is appropriate for small to medium perforations in ears with an intact ossicular chain and no active infection. The surgeon harvests a graft, typically from the temporalis fascia (a tough membrane covering the temple muscle), perichondrium (tissue covering ear cartilage), or cartilage itself, and places it under or over the perforation to serve as a scaffold for the eardrum to heal. The procedure can be performed through the ear canal (transcanal approach) for small, accessible perforations, or through an incision behind the ear (postauricular approach) for larger or more posteriorly located perforations.

Tympanoplasty encompasses not only eardrum repair but also reconstruction of the middle ear sound-conducting mechanism when the ossicles are damaged, eroded, or fixated. The ossicular chain, consisting of the malleus (hammer), incus (anvil), and stapes (stirrup), transmits sound vibrations from the eardrum to the inner ear. Chronic infection, cholesteatoma, or trauma can damage these tiny bones, further compromising hearing beyond what the eardrum perforation alone causes. Ossicular reconstruction techniques include repositioning existing ossicles, using prosthetic partial or total ossicular replacement prostheses, or fashioning grafts from the patient's own cartilage or bone. At Memorial Şişli Hospital, experienced otological surgeons perform both myringoplasty and complex tympanoplasty with ossicular reconstruction, using operating microscopes and microsurgical instruments that allow precise manipulation of the delicate middle ear structures.

Cartilage tympanoplasty has gained popularity as an alternative to traditional fascial grafting, particularly for large perforations, revision cases, and patients at high risk of recurrent perforation. Cartilage grafts, typically harvested from the tragus or concha of the ear, provide greater structural stability and resistance to retraction compared to fascial grafts, resulting in higher long-term graft take rates in challenging cases. Various cartilage tympanoplasty techniques are used including palisade, butterfly, and island cartilage grafts, each suited to different perforation sizes and locations. Endoscopic ear surgery, using a rigid endoscope instead of an operating microscope, is an emerging approach that provides superior visualization of the middle ear anatomy through the ear canal, potentially allowing more procedures to be performed without a postauricular incision.

• Myringoplasty — simple eardrum repair without ossicular reconstruction
• Tympanoplasty Type I — eardrum repair with intact ossicular chain
• Tympanoplasty Type II — repair with minor ossicular deficiency correction
• Tympanoplasty Type III — eardrum grafted onto stapes for damaged malleus/incus
• Tympanoplasty Type IV — graft protects round window when stapes is mobile
• Cartilage tympanoplasty — uses ear cartilage graft for stronger repair
• Endoscopic tympanoplasty — minimally invasive approach through ear canal

Cost Comparison by Country

Tympanoplasty Cost Comparison 2025

Myringoplasty is a simpler eardrum patch procedure. Tympanoplasty involves eardrum repair plus middle ear reconstruction. Prices include surgery, anesthesia, and hospital charges.

Turkey offers exceptional value for ear surgery abroad, with myringoplasty available for $1,200 to $2,500 and more complex tympanoplasty with ossicular reconstruction for $2,000 to $4,000 at leading hospitals. Acıbadem Maslak Hospital employs board-certified otological surgeons who perform these procedures regularly using high-powered operating microscopes and precision microsurgical instruments. The total cost of tympanoplasty in Turkey, including round-trip airfare and one week of accommodation, is typically well under half the cost of the surgery alone in the United States, making it an attractive option for patients seeking quality ear surgery at an affordable price.

What to Expect During Tympanoplasty

Tympanoplasty is typically performed under general anesthesia and takes one to three hours depending on the complexity of the repair and whether ossicular reconstruction is required. The surgeon may approach the ear through the ear canal (transcanal) for simple repairs or through an incision behind the ear (postauricular) for more complex cases that require better access to the middle ear. A graft is harvested, usually from the temporalis fascia or tragal cartilage, and prepared for placement. The surgeon carefully lifts the remaining eardrum, inspects the middle ear cavity and ossicular chain, addresses any disease or structural abnormalities, and then positions the graft to close the perforation.

The ear canal is packed with absorbable packing material that supports the graft during the initial healing period and dissolves on its own over the following weeks. Most patients go home the same day or after one night in the hospital. Post-operative instructions include keeping the ear dry, avoiding nose blowing and sneezing with the mouth closed, and limiting physical activity for two to three weeks. Antibiotic ear drops are typically prescribed for the first week to prevent infection. Follow-up appointments at one to two weeks and at one month allow the surgeon to assess graft healing and begin removing packing material. Hearing testing is performed at approximately two to three months when the graft has fully healed and the ear canal packing has been absorbed.

Recovery & Hearing Outcomes

Recovery from tympanoplasty is generally straightforward, with most patients experiencing minimal pain that is easily managed with oral analgesics. The most common post-operative complaints include a feeling of fullness in the ear, mild hearing impairment during the healing period due to packing material in the ear canal, and occasional mild dizziness. These symptoms gradually resolve over the first four to six weeks as the packing dissolves and the graft heals. Most patients return to work within one to two weeks for desk-based occupations, with physical labor requiring three to four weeks off. Air travel should be avoided for at least two to three weeks after surgery to prevent pressure changes that could dislodge the graft.

Hearing outcomes after tympanoplasty depend on the size of the original perforation, the status of the ossicular chain, and the degree of middle ear disease. For simple myringoplasty with an intact ossicular chain, hearing improvement is expected in 80 to 90 percent of patients, with many achieving closure of the air-bone gap to within 10 dB of normal. When ossicular reconstruction is performed, hearing outcomes are more variable, with approximately 60 to 80 percent of patients achieving meaningful hearing improvement. Graft take rates (successful closure of the perforation) range from 85 to 95 percent for primary procedures at experienced centers, with cartilage grafts showing slightly higher take rates than fascial grafts in challenging cases.

Choosing Your Otological Surgeon

Selecting the right surgeon for tympanoplasty requires attention to their specific experience and training in otological (ear) surgery. While all ENT surgeons receive training in ear surgery during residency, tympanoplasty and ossicular reconstruction are technically demanding procedures that benefit greatly from subspecialty expertise and high surgical volume. Look for surgeons who have completed fellowship training in otology or neurotology, who perform tympanoplasty regularly, and who can provide outcome data including graft take rates and hearing results. At Acıbadem Maslak Hospital, the otology team includes surgeons with subspecialty training and extensive experience in microsurgical ear procedures.

Memorial Şişli Hospital and Anadolu Medical Center offer additional options for ear surgery in Turkey, each with experienced otological surgeons and well-equipped operating theaters. For patients considering other destinations, Acıbadem Taksim Hospital provides convenient access in central Istanbul with the same high standards of surgical care available across the Acıbadem network. The key to a successful outcome is choosing a surgeon and facility with proven expertise in the specific type of ear surgery you need, and all these centers meet that standard through their track records and accreditation.

After years of protecting my ear from water and dealing with recurrent infections, my tympanoplasty in Istanbul finally solved the problem. The surgery was precise, recovery was smooth, and my hearing has improved significantly. All for a fraction of what I was quoted at home.

Stephen D., tympanoplasty patient from Ireland

Frequently Asked Questions